General Compared with Spinal Anesthesia for Total Hip Arthroplasty

Basques, Bryce A.; Toy, Jason O.; Bohl, Daniel D.; Golinvaux, Nicholas S.; Grauer, Jonathan N.

doi:10.2106/jbjs.n.00662

Cited by 179 publications

(134 citation statements)

References 30 publications

(37 reference statements)

Supporting

Mentioning

120

Contrasting

Unclassified

Order By: Relevance

“…In terms of the fracture type, 3.3% were open fractures, and 27.3% were trimalleolar fractures ( Table 1). …”

Section: Resultsmentioning

confidence: 99%

Most Readmissions Following Ankle Fracture Surgery Are Unrelated to Surgical Site Issues

Young

Cody

et al. 2017

Foot & Ankle Orthopaedics

View full text Add to dashboard Cite

Background: Ankle fracture surgeries are generally safe and effective procedures; however, as quality-based reimbursement models are increasingly affected by postoperative readmission, we aimed to determine the causes and risk factors for readmission following ankle fracture surgery. Methods: Ankle fracture cases were identified from the prospectively collected American College of Surgeons National Surgical Quality Improvement Program from 2013 to 2014. Demographics, comorbidities, and fracture characteristics were collected. Rates of 30-day adverse events and readmissions were determined as well as the causes for readmission. Multivariable logistic regression analyses were performed to identify risk factors associated with having any adverse events and being readmitted within 30 days of surgery. Results: There were 5056 patients included; 167 (3.3%) were open fractures. The rate of any postoperative adverse event was 5.2%. There were 116 unplanned readmissions, with a readmission rate of 2.3%. Of the 116 unplanned readmissions, 49 (42.2%) were for reasons related to the surgery or surgical site, with the most common causes being deep surgical site/ hardware infections (12.9%), superficial site infections (11.2%), and wound disruption (6.9%). Most readmissions were for reasons unrelated to the surgical site (51.7%), including cardiac disorders (8.6%), pulmonary disorders (7.8%), and neurological/psychiatric disorders (6.9%). The cause of readmission was unknown for 6% of readmissions. With multivariable logistic regression, the strongest risk factors for readmission were a history of pulmonary disease (odds ratio [OR], 2.29), American Society of Anesthesiologists (ASA) class 3 (OR, 2.28), and open fractures (OR, 2.04) (all P < .05). Conclusion: In this cohort of 5056 ankle fracture cases, 2.3% of patients were readmitted within 30 days, with at least 51.7% of all unplanned readmissions due to causes unrelated to the surgery or surgical site. Predictors of readmission included a history of pulmonary disease, higher ASA class, and open fractures. Based on these findings, we advocate close medical follow-up with nonorthopaedic providers after discharge for high-risk patients. Level of Evidence: Level III.

show abstract

“…In terms of the fracture type, 3.3% were open fractures, and 27.3% were trimalleolar fractures ( Table 1). …”

Section: Resultsmentioning

confidence: 99%

Most Readmissions Following Ankle Fracture Surgery Are Unrelated to Surgical Site Issues

Young

Cody

et al. 2017

Foot & Ankle Orthopaedics

View full text Add to dashboard Cite

show abstract

“…And the purpose of this study was to determine the prevalence of malnutrition across various obesity classes in patients undergoing primary elective TKA and to compare (2) What are the independent associations between malnutrition, obesity, and postoperative complications following TKA?.…”

Section: Introductionmentioning

confidence: 99%

Hypoalbuminemia Is a Better Predictor than Obesity of Complications After Total Knee Arthroplasty: a Propensity Score-Adjusted Observational Analysis

McLawhorn

Padgett

et al. 2016

HSS Jrnl

View full text Add to dashboard Cite

Background: Obesity is an established risk factor for complications after total knee arthroplasty (TKA) and is often associated with malnutrition. Questions/Purposes: 1. What is the prevalence of hypoalbuminemia in obese patients undergoing TKA? 2. What is the independent morbidity risk of malnutrition relative to obesity? Methods: TKA cases were identified from the National Surgical Quality Improvement Program from 2005 to 2013. Propensity scores for having preoperative albumin measurements were calculated using demographics, BMI, and modified Charlson Comorbidity Index (CCI). Malnutrition was defined as hypoalbuminemia (<3.5 g/dL). Patients were classified by BMI as follows: non-obese (18.5-29.9), obese I (30-34.9), obese II (35-39.9), or obese III (≥40). Postoperative complications were compared across obesity and nutritional statuses. Multivariable propensity-adjusted logistic regressions were performed to determine associations between malnutrition, obesity, and 30-day outcomes. Results: There were 71,599 cases identified, with 34,800 (48.6%) having albumin measurements. Propensity score adjustment adequately accounted for selection bias, with adjusted p > 0.05 for observable characteristics. Malnutrition prevalence increased with BMI (6.1% in obese III vs. 3.7% in non-obese). With propensity-adjusted multivariable analysis, obese III was the only obesity class associated with any complication, wound complication, and reoperation. Hypoalbuminemia was a stronger and more consistent independent risk factor, for any complication, wound, cardiac, or respiratory complications, and death. Conclusions: Hypoalbuminemia is a more consistent independent predictor of complications after TKA than obesity. Strategies for medical optimization of these conditions should be investigated.

show abstract

“…[12][13][14][15][16][17] Subsequent studies, however, have yielded more conflicting results. [18][19][20][21][22][23][24][25] Much of the available research investigating complications after arthroplasty lacks accurate information on specific infectious diseases or fails to incorporate data relevant to the anesthetic technique itself. Of the meta-analyses that have been conducted examining the risk factors of SSI after KA or HA, none has studied the relationship between the anesthetic technique itself in the development of postoperative SSI.…”

mentioning

confidence: 99%

The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty

Zorrilla-Vaca

Grant

Mathur

et al. 2016

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

show abstract

General Compared with Spinal Anesthesia for Total Hip Arthroplasty

Cited by 179 publications

References 30 publications

Most Readmissions Following Ankle Fracture Surgery Are Unrelated to Surgical Site Issues

Most Readmissions Following Ankle Fracture Surgery Are Unrelated to Surgical Site Issues

Hypoalbuminemia Is a Better Predictor than Obesity of Complications After Total Knee Arthroplasty: a Propensity Score-Adjusted Observational Analysis

The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty

Contact Info

Product

Resources

About